1. Approach to Obesity DR.YOUSEF ABDULLAH AL TURKI MBBS,DPHC,ABFM Consultant Family Medicine Associatet professor King Khalid University Hospital College of Medicine King Saud University

2. Scenario Ahmed 42 years old come to primary care clinic complain of bilateral joint pain for the last 6 month. Weight: 96 kg Height: 162 cm HOW YOU WILL APPROACH AHMED?

3. Calculate BMI for Ahmed? BMI= weight (kg)/ height (m)2 BMI for Ahmed = 96/(1.62)×(1.62) = 96/2.6244 = 36.58

4. Classify Obesity? Normal: 18.5 - < 25 Overweight: 25- < 30 Obesity grade 1: 30- < 35 Obesity grade 2: 35- < 40 Morbid obesity: ?????

5. How obese patient come to the clinic? Opportunistic health promotion Complication of Obesity: Examples? Social reason: What others?

6. What are the prevalence of obesity in Saudi Arabia? National Community based survey All different regions in K.S.A Adult > 15 years Sample size: 13177 adults( male and female).

7. Results of the community survey BMI>30 ??? Male: 16% Female: 24% BMI 25-30 ??? Male: 29% Female: 27%

8. How to prevent Obesity? The best way to manage obesity in the community is to prevent it!!! Childhood obesity Weaning and feeding Health education

9. What are the causes of obesity? Life styles changes: Common dietary habits: Why?! sedentary life lack of physical activity Genetic factors: Secondary obesity: Examples??

10. Scenario Khalid 22 years old university student come to primary care clinic concern about his weight, and want to get drug to decrease his weight very soon? Weight: 112kg height: 170 cm How you can help Khalid to lower his weight?

11. What are the Evidence based approach to decrease the weight? Dietary approach: - eat small quantity of your suitable food - eat fruits and vegetables - decrease sweet and fat - minimize fast food - avoid too much snacks - balance diet

12. What are the Evidence based approach to decrease the weight? Behavioral approach: - start from now - set a realistic objective: 1kg/month - always use small plate - avoid eating in front of TV - avoid shopping when you are hungry

13. What are the Evidence based approach to decrease the weight? Physical activity: - start by increase your daily activity - walk for about 30 minute/ day - do not seat for long time in front of TV, play station, etc - choose suitable exercise for your age, gender, and time. - always think about continuity of programme to reach and maintain your ideal body weight for the rest of your life.

14. Team approach Family involvement School involvement Health team support Other community related sectors

15. What are the evidence of drug treatment for obesity? Short term effect Side effects Need close health team supervision Not recommended in evidence based approach

16. What are the evidence of herbal medicine for obesity? The contents of herbal medicine in the markets???? Side effects Not recommended because Lack of scientific evidence and possible side effect

17. What are the evidence of surgical approach? Could be an option for morbid obesity if dietary and exercise approach fail after 12 month of real trial under health team supervision. Start and continue all the life time by dietary and behavioral approach for all patient. Side effect: ?? discuss with patient advantages and disadvantages

18. CONCLUSIONS The best way to decrease the prevalence of obesity is to prevent it. Dietary, behavioral and exercise had long term effects to maintain ideal body weight. It is important to involve entire family when treat obesity.

19. WITH MY BEST REGARDS